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2763 Medicine

A 22-year-old man develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. Which test or group of tests would be most supportive of your suspected diagnosis?

AMRI of the lumbosacral spine showing spinal compression fractures associated with bony destruction.
BAn elevated sedimentation rate, a mild anemia on CBC, positive HLA-B27 in blood and sclerosis of the sacroiliac joints on plain films of the back.
CA positive rheumatoid factor, anti-CCP, and an elevated C-reactive protein level.
DLumbosacral x-rays showing vertebral joint space narrowing and osteophyte formation at various levels.
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